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For the overwhelming majority of things people to go to the hospital for, where you go doesn't really matter, because the treatment and diagnosis is extremely r

For the overwhelming majority of things people to go to the hospital for, where you go doesn't really matter, because the treatment and diagnosis is extremely routine. This includes very serious things like cancer. My mother, through a variety of fortuitous events, was able to have her breast cancer treated at one of the top ranked cancer specializing hospitals in the US. She had acquaintances that had theirs treated at the local university/training hospital. They ended up receiving literally the exact same treatments. Same for my own stuff. The first time one of my children got sick it was terrifying, so I naturally took him to the most premium pediatric healthcare institution. And what did they do? Basic tests to rule out anything particularly nasty, and fever management. The exact same thing the cheapest hospital does, except I got the privilege of paying 10x more for it and feeling like a complete sucker. From that point on - 'oh he's sick? shall we go to the university hospital, or the religious nonprofit?'

owenthejumper 1y ago
Unfortunately it does matter. NCI designated cancer centers simply do have better outcomes than local hospitals.
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- somenameforme 1y ago
  This is not entirely clear. Elsewhere in this thread I found a couple of studies on this exact topic. The first [1] is just for breast cancer and after normalizing across a wide array of variables, found no improved survival rates except for black women, which I think is suggestive of further biases. The second [2] is for all sorts of cancers, but is a large observational study without much effort to control for biases. It found an overall increase in five year survival rates of 3.6% (64.3% in NCI centers, vs 60.7% in non-NCI). That's certainly something, but it's fairly certain that biases would bring that down a healthy chunk. However there were significantly better outcomes in more rare/lethal cancers. For instance in hepatobiliary cancers, the NCI survival rate was 33.8% vs 18.7% for non-NCI centers. And that is largely the point I'm making. For the overwhelming majority of things, care is mostly commoditized and you will be fine wherever you go. The value of high end institutions is mostly only realized in the case of rare/serious issues, for which transfer is always an option anyhow. --- Though I'd also add here that these examples, cancer, are on the fringe extremes of what my point was. That there is a strong argument to be made that even cancer falls within it, just further emphasizes the point. If your local hospital can competently treat cancer, they can certainly treat the overwhelming majority of reasons people go to the hospital, which are relatively far more commoditized. [1] - https://pmc.ncbi.nlm.nih.gov/articles/PMC8462568/ https://pmc.ncbi.nlm.nih.gov/articles/PMC8462568/ [2] - https://pmc.ncbi.nlm.nih.gov/articles/PMC4892698/ https://pmc.ncbi.nlm.nih.gov/articles/PMC4892698/
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  - epcoa 1y ago
    "can competently treat cancer, they can certainly treat the overwhelming majority of reasons" No this claim, just because, is not weight-bearing. Extraordinary claims require extraordinary evidence. And I don't understand the motivation to make such a tenuous link when at a bare minimum one can look up direct data like joint commision and MPSMS safety data and related publications. There is tremendous variability in serious hospital safety events inter-institution for bread and butter admissions. One can further just examine CMS and NHS data for mortality and readmission for "mundane" MI, HF, sepsis, pneumonia, respiratory failure. OB/GYN outcomes are their own thing. The flaw in reasoning here is that quality of care and outcomes is strongly related to the simplicity of diagnosis. A further flaw is the belief that care is "commoditized". Treatment protocols vary widely across institutions and health systems, often times based on cost factors. Certain basic things can not be done at night, or even the day for fully accredited hospitals. There's a big difference somewhere with 24 hour anesthesia airway and in-house surgery and not just an intensivist "on call" 600 miles away and staff that can't even do RSI. Transfer is not always an option, there's a reason critically ill people die more frequently in the sticks. If one is admitted to a regional hospital, they are unlikely to be accepted for transfer to a safer hospital unless they truly need an intervention that absolutely cannot be provided where they are, not simply because there is better backup provider support and a higher standard of safety. They will still remain at that higher risk for sepsis, or outdated care because the community physician group doesn't keep up with guidelines, or that hospital only offers the inferior treatment (or a limited formulary) for cost-cutting reasons. Breast cancer and most cancers are not even typical inpatient encounters. Breast cancer is generally not managed on an inpatient basis, in fact one may never even have to visit an inpatient hospital campus for breast cancer. Upgrades for cancer are usually different than acute inpatient care. Breast cancer does not usually involve abdominal, intrathoracic or orthopedic surgery. Breast cancer does not usually involve advanced interventions like endarterectomy, ECMO. Cancer is a special case. Regardless of complexity, extrapolating cancer treatment to even the most "mundane" acute inpatient or surgical care really is beyond ridiculous. This is a complex subject and this is a silly hot take.
yibg 1y ago
This isn’t true in aggregate though. Cancer treatment outcomes varies quite a bit even for the same type of cancer.
epcoa 1y ago
EDIT: tl;dr Two registry cohort papers on breast cancer outcomes, one only in Los Angeles county "provide extensive evidence for my claim" The claim: For the overwhelming majority of things people to go to the hospital for, where you go doesn't really matter. Ok, whatever.
- somenameforme 1y ago
  This is not anecdotal. At least for the cancer we're discussing, breast cancer, there is no meaningful difference between hospitals. Here [1] is a study on this exact question for breast cancer. They covered an extensive number of variables across hospitals and patients (including NCI/ACS status). They found no correlation with improved survival rates for any variable except for black women receiving their initial treatment at an ACS hospital. While that is technically an affirmation of your claims, I think it is clearly suggestive of some form of bias rather than being a clear causal association. [1] - https://pmc.ncbi.nlm.nih.gov/articles/PMC8462568/ https://pmc.ncbi.nlm.nih.gov/articles/PMC8462568/
  - epcoa 1y ago
    .
    - somenameforme 1y ago
      I said for the overwhelming majority of things people go to the hospital for. And the overwhelming majority would be things far more commoditized than cancer - stomach aches, injuries, fevers, infections, cardiovascular issues, etc. I chose breast cancer because it is the most common type of cancer and at the extreme fringes of my what comment might cover. It just so happens that my comment does cover it as well. Incidentally, it's also the same story for colorectal cancer, the 2nd most common type of cancer. Here's another study on the topic. [1] They have a survival rate of 88.6 vs 85.9 for breast cancer, but it's a large observational study that's not normalized, so the confounders/biases there probably explain the reduction in survival rate at non-NIC hospitals. Colorectal cancer is even smaller - 0.2%. NIC hospitals only showed a significant effect on cancers with low survival rates, and especially on rarer cancers. For instance with pancreatic cancer 93.8% of people who went to a non-NIC hospital were dead in 5 years, by contrast 'only' 87.5% of NIC hospital patients were. Feel free to look up the data yourself. I'm not searching for cherry picked studies, there are none - as there seem to be oddly few studies on this question, and they all say the same thing. What benefit there is is quite small, and heavily driven by extremely rare things. [1] - https://pmc.ncbi.nlm.nih.gov/articles/PMC4892698/ https://pmc.ncbi.nlm.nih.gov/articles/PMC4892698/

owenthejumper 1y ago

Unfortunately it does matter. NCI designated cancer centers simply do have better outcomes than local hospitals.

deleted 1y ago
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somenameforme 1y ago
This is not entirely clear. Elsewhere in this thread I found a couple of studies on this exact topic. The first [1] is just for breast cancer and after normalizing across a wide array of variables, found no improved survival rates except for black women, which I think is suggestive of further biases. The second [2] is for all sorts of cancers, but is a large observational study without much effort to control for biases. It found an overall increase in five year survival rates of 3.6% (64.3% in NCI centers, vs 60.7% in non-NCI). That's certainly something, but it's fairly certain that biases would bring that down a healthy chunk. However there were significantly better outcomes in more rare/lethal cancers. For instance in hepatobiliary cancers, the NCI survival rate was 33.8% vs 18.7% for non-NCI centers. And that is largely the point I'm making. For the overwhelming majority of things, care is mostly commoditized and you will be fine wherever you go. The value of high end institutions is mostly only realized in the case of rare/serious issues, for which transfer is always an option anyhow. --- Though I'd also add here that these examples, cancer, are on the fringe extremes of what my point was. That there is a strong argument to be made that even cancer falls within it, just further emphasizes the point. If your local hospital can competently treat cancer, they can certainly treat the overwhelming majority of reasons people go to the hospital, which are relatively far more commoditized. [1] - https://pmc.ncbi.nlm.nih.gov/articles/PMC8462568/ https://pmc.ncbi.nlm.nih.gov/articles/PMC8462568/ [2] - https://pmc.ncbi.nlm.nih.gov/articles/PMC4892698/ https://pmc.ncbi.nlm.nih.gov/articles/PMC4892698/
- deleted 1y ago
  [deleted]
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- epcoa 1y ago
  "can competently treat cancer, they can certainly treat the overwhelming majority of reasons" No this claim, just because, is not weight-bearing. Extraordinary claims require extraordinary evidence. And I don't understand the motivation to make such a tenuous link when at a bare minimum one can look up direct data like joint commision and MPSMS safety data and related publications. There is tremendous variability in serious hospital safety events inter-institution for bread and butter admissions. One can further just examine CMS and NHS data for mortality and readmission for "mundane" MI, HF, sepsis, pneumonia, respiratory failure. OB/GYN outcomes are their own thing. The flaw in reasoning here is that quality of care and outcomes is strongly related to the simplicity of diagnosis. A further flaw is the belief that care is "commoditized". Treatment protocols vary widely across institutions and health systems, often times based on cost factors. Certain basic things can not be done at night, or even the day for fully accredited hospitals. There's a big difference somewhere with 24 hour anesthesia airway and in-house surgery and not just an intensivist "on call" 600 miles away and staff that can't even do RSI. Transfer is not always an option, there's a reason critically ill people die more frequently in the sticks. If one is admitted to a regional hospital, they are unlikely to be accepted for transfer to a safer hospital unless they truly need an intervention that absolutely cannot be provided where they are, not simply because there is better backup provider support and a higher standard of safety. They will still remain at that higher risk for sepsis, or outdated care because the community physician group doesn't keep up with guidelines, or that hospital only offers the inferior treatment (or a limited formulary) for cost-cutting reasons. Breast cancer and most cancers are not even typical inpatient encounters. Breast cancer is generally not managed on an inpatient basis, in fact one may never even have to visit an inpatient hospital campus for breast cancer. Upgrades for cancer are usually different than acute inpatient care. Breast cancer does not usually involve abdominal, intrathoracic or orthopedic surgery. Breast cancer does not usually involve advanced interventions like endarterectomy, ECMO. Cancer is a special case. Regardless of complexity, extrapolating cancer treatment to even the most "mundane" acute inpatient or surgical care really is beyond ridiculous. This is a complex subject and this is a silly hot take.

yibg 1y ago

This isn’t true in aggregate though. Cancer treatment outcomes varies quite a bit even for the same type of cancer.

epcoa 1y ago

EDIT: tl;dr Two registry cohort papers on breast cancer outcomes, one only in Los Angeles county "provide extensive evidence for my claim" The claim: For the overwhelming majority of things people to go to the hospital for, where you go doesn't really matter. Ok, whatever.

somenameforme 1y ago
This is not anecdotal. At least for the cancer we're discussing, breast cancer, there is no meaningful difference between hospitals. Here [1] is a study on this exact question for breast cancer. They covered an extensive number of variables across hospitals and patients (including NCI/ACS status). They found no correlation with improved survival rates for any variable except for black women receiving their initial treatment at an ACS hospital. While that is technically an affirmation of your claims, I think it is clearly suggestive of some form of bias rather than being a clear causal association. [1] - https://pmc.ncbi.nlm.nih.gov/articles/PMC8462568/ https://pmc.ncbi.nlm.nih.gov/articles/PMC8462568/
- epcoa 1y ago
  .
  - somenameforme 1y ago
    I said for the overwhelming majority of things people go to the hospital for. And the overwhelming majority would be things far more commoditized than cancer - stomach aches, injuries, fevers, infections, cardiovascular issues, etc. I chose breast cancer because it is the most common type of cancer and at the extreme fringes of my what comment might cover. It just so happens that my comment does cover it as well. Incidentally, it's also the same story for colorectal cancer, the 2nd most common type of cancer. Here's another study on the topic. [1] They have a survival rate of 88.6 vs 85.9 for breast cancer, but it's a large observational study that's not normalized, so the confounders/biases there probably explain the reduction in survival rate at non-NIC hospitals. Colorectal cancer is even smaller - 0.2%. NIC hospitals only showed a significant effect on cancers with low survival rates, and especially on rarer cancers. For instance with pancreatic cancer 93.8% of people who went to a non-NIC hospital were dead in 5 years, by contrast 'only' 87.5% of NIC hospital patients were. Feel free to look up the data yourself. I'm not searching for cherry picked studies, there are none - as there seem to be oddly few studies on this question, and they all say the same thing. What benefit there is is quite small, and heavily driven by extremely rare things. [1] - https://pmc.ncbi.nlm.nih.gov/articles/PMC4892698/ https://pmc.ncbi.nlm.nih.gov/articles/PMC4892698/